OBJECTIVE: To evaluate whether labor is associated with lower odds of respiratory morbidity among neonates born from 36 to 40 weeks of gestation and to assess whether this association varies by gestational age and maternal diabetic status. METHODS: We conducted a secondary analysis of women in the Assessment of Perinatal Excellence obstetric cohort who delivered across 25 U.S. hospitals over a 3-year period. Women with a singleton liveborn non-anomalous neonate who delivered from 36 to 40 weeks of gestation were included in our analysis. Those who received antenatal corticosteroids, underwent amniocentesis for fetal lung maturity, or did not meet dating criteria were excluded. Our primary outcome was composite neonatal respiratory morbidity, which included respiratory distress syndrome, ventilator support, continuous positive airway pressure, or neonatal death. Maternal characteristics and neonatal outcomes between women who labored and those who did not were compared. Multivariable logistic regression models were used to evaluate the association between labor and the primary outcome. Interactions between labor and diabetes mellitus and labor and gestational age were tested. RESULTS: Our analysis included 63,187 women who underwent labor and 10,629 who did not. There was no interaction between labor and diabetes mellitus (P=.90). However, there was a significant interaction between labor and gestational age (P=.01). In the adjusted model, labor was associated with lower odds of neonatal respiratory morbidity compared with no labor for neonates delivered from 36-39 weeks of gestation. A 1-week increase in gestational age was associated with a 1.2 times increase in the adjusted odds ratio for the neonatal outcome comparing labor and no labor. CONCLUSION: Labor was associated with lower odds of the composite outcome among neonates delivered from 36-39 weeks of gestation. The magnitude of this association varied by gestational age. The association was similar for women with or without diabetes mellitus.

IMPORTANCE Administration of corticosteroids to women at high risk for delivery in the late preterm period (34-36 weeks' gestation) improves short-term neonatal outcomes. The cost implications of this intervention are not known. OBJECTIVE To compare the cost-effectiveness of treatment with antenatal corticosteroids with no treatment for women at risk for late preterm delivery. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of the Antenatal Late Preterm Steroids trial, a multicenter randomized clinical trial of antenatal corticosteroids vs placebo in women at risk for late preterm delivery conducted from October 30, 2010, to February 27, 2015. took a third-party payer perspective. Maternal costs were based on Medicaid rates and included those of betamethasone, as well as the outpatient visits or inpatient stay required to administer betamethasone. All direct medical costs for newborn care were included. For infants admitted to the neonatal intensive care unit, comprehensive daily costs were stratified by the acuity of respiratory illness. For infants admitted to the regular newborn nursery, nationally representative cost estimates from the literature were used. Effectiveness was measured as the proportion of infants without the primary outcome of the study: a composite of treatment in the first 72 hours of continuous positive airway pressure or high-flow nasal cannula for 2 hours or more, supplemental oxygen with a fraction of inspired oxygen of 30% or more for 4 hours or more, and extracorporeal membrane oxygenation or mechanical ventilation. This secondary analysis was initially started in June 2016 and revision of the analysis began in May 2017. EXPOSURES Betamethasone treatment. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio. RESULTS Costs were determined for 1426 mother-infant pairs in the betamethasone group (mean [SD] maternal age, 28.6 [6.3] years; 827 [58.0%] white) and 1395 mother-infant pairs in the placebo group (mean [SD] maternal age, 27.9 [6.2] years; 794 [56.9%] white). Treatment with betamethasone was associated with a total mean (SD) woman-infant-pair cost of $4681($5798), which was significantly less than the mean (SD) amount of $5379 ($8422) for women and infants in the placebo group (difference, $698; 95% CI, $186-$1257; P =.02). The Antenatal Late Preterm Steroids trial determined that betamethasone use is effective: respiratory morbidity decreased by 2.9% (95% CI,-0.5% to-5.4%). Thus, the cost-effectiveness ratio was-$23 986 per case of respiratory morbidity averted. Inspection of the bootstrap replications confirmed that treatment was the dominant strategy in 5000 samples (98.8%). Sensitivity analyses showed that these results held under most assumptions. CONCLUSIONS AND RELEVANCE The findings suggest that antenatal betamethasone treatment is associated with a statistically significant decrease in health care costs and with improved outcomes; thus, this treatment may be an economically desirable strategy.

Objective: To determine the association of maternal glycemia with childhood obesity and metabolic dysfunction. Study design: Secondary analysis of follow-up data 5?10?years after a mild gestational diabetes mellitus (GDM) treatment trial. The relationship between maternal oral glucose tolerance testing (OGTT) at 24?31-week gestation and body mass index (BMI), fasting glucose, insulin, and anthropometric measurements (sum of skinfolds, subscapular/triceps ratio, and waist circumference) in the offspring of untreated mild GDM and non-GDM (abnormal 50-g screen/normal OGTT) women was assessed. Multivariable regression modeling controlling for maternal and neonatal characteristics was employed. Results: A cohort of 236 untreated mild GDM and 480 non-GDM offspring were analyzed. In the combined cohort, significant correlations existed between fasting, 1, 2, and 3?h maternal glucose and subscapular/triceps ratio (all p?<?.04) and in all OGTT values other than the 2-hour value for homeostatic model assessment-estimated insulin resistance (HOMA-IR) (all p?<?.04) and sum of skinfold measurements (all p?<?.03). No correlation was found between OGTT values and childhood BMI Z-score. Multivariable regression modeling showed that OGTT values were associated with only sum of skinfolds and subscapular/triceps ratio and not with childhood BMI Z-score. Hispanic ethnicity and prepregnancy maternal BMI were most consistently related to childhood BMI Z-score and HOMA-IR, and Hispanic ethnicity with fasting glucose. Conclusions: Among women with untreated mild GDM and those without GDM, maternal glycemia is associated with childhood anthropometric measures of obesity but not childhood BMI, fasting glucose, or insulin resistance. Hispanic ethnicity, maternal BMI, and gestational weight gain were consistently related to childhood BMI.

Objective To assess the risk of ischemic placental disease (IPD) including preeclampsia, small for gestational age (SGA), and abruption, in relation to preeclampsia in maternal grandmother, mother, and sister(s). Study Design We performed a secondary analysis of data from a randomized trial of vitamins C and E for preeclampsia prevention. Data on family history of preeclampsia were based on recall by the proband. The associations between family history of preeclampsia and the odds of IPD were evaluated from alternating logistic regressions. Results Of the 9,686 women who delivered nonmalformed, singleton live births, 17.1% had IPD. Probands provided data on preeclampsia in 55.5% ( n =5,374) on all three family members, 26.5% ( n =2,562) in mother and sister(s) only, and 11.6% ( n =1,125) in sister(s) only. The pairwise odds ratio (pOR) of IPD was 1.16 (95% confidence interval [CI]: 1.00-1.36) if one or more of the female relatives had preeclampsia. The pORs of preeclampsia were 1.54 (95% CI: 1.12-2.13) and 1.35 (95% CI: 1.03-1.77) if the proband's mother or sister(s) had a preeclamptic pregnancy, respectively, but no associations were seen for SGA infant or abruption. Conclusion This study suggests that IPD may share a predisposition with preeclampsia, suggesting a familial inheritance.

ABSTRACTObjectiveTo evaluate whether the presence of cervical funneling or intra‐amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile).MethodsThis was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17‐alpha‐hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra‐amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra‐amniotic debris with PTB.ResultsOf the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra‐amniotic debris only and 45 (7%) had both on second‐trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5–3.3)) or intra‐amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1–2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra‐amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00–3.44) and aOR, 2.78 (95% CI, 1.42–5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63–2.17) and aOR, 1.45 (95% CI, 0.71–2.96), respectively).ConclusionsAmong asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra‐amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

OBJECTIVE:We sought to evaluate the frequency of, and factors associated with, the use of 3 evidence-based interventions: antenatal corticosteroids for fetal lung maturity, progesterone for prevention of recurrent preterm birth, and magnesium sulfate for fetal neuroprotection.STUDY DESIGN:A self-administered survey was conducted from January through May 2011 among obstetricians from 21 hospitals that included 30 questions regarding their knowledge, attitudes, and practice of the 3 evidence-based interventions and the 14-item short version of the Team Climate for Innovation survey. Frequency of use of each intervention was ascertained from an obstetrical cohort of women between January 2010 and February 2011.RESULTS:A total of 329 obstetricians (74% response rate) who managed 16,946 deliveries within the obstetrical cohort participated in the survey. More than 90% of obstetricians reported that they incorporated each intervention into routine practice. Actual frequency of administration in women eligible for the treatments was 93% for corticosteroids, 39% for progesterone, and 71% for magnesium sulfate. Provider satisfaction with quality of treatment evidence was 97% for corticosteroids, 82% for progesterone, and 57% for magnesium sulfate. Obstetricians perceived that barriers to treatment were most frequent for progesterone (76%), 30% for magnesium sulfate, and 17% for corticosteroids. Progesterone use was more frequent among patients whose provider reported the quality of the evidence was above average to excellent compared with poor to average (42% vs 25%, respectively; P < .001), and they were satisfied with their knowledge of the intervention (41% vs 28%; P = .02), and was less common among patients whose provider reported barriers to hospital or pharmacy drug delivery (31% vs 42%; P = .01). Corticosteroid administration was more common among patients who delivered at hospitals with 24 hours a day-7 days a week maternal-fetal medicine specialist coverage (93% vs 84%; P = .046), CONCLUSION: Obstetricians in Maternal-Fetal Medicine Units Network hospitals frequently use these evidence-based interventions; however, progesterone use was found to be related to their assessment of evidence quality. Neither progesterone nor the other interventions were associated with overall climate of innovation within a hospital as measured by the Team Climate for Innovation. National Institutes of Health Consensus Conference Statements may also have an impact on use; there is such a statement for antenatal corticosteroids but not for progesterone for preterm prevention or magnesium sulfate for fetal neuroprotection.

Women with periviable birth (PVB) are at increased risk for preterm birth in future pregnancies. However, little is known about the proximate causes of recurrence and their concordance between pregnancies. Our goal was to determine if there is a consistent pattern of causes of PVB when it recurs. Women with 2 or more singleton PVBs between 20 and 26 weeks gestation from 1974-2012 were identified from our perinatal database. We retrospectively reviewed the events around delivery, including proximate cause. Concordance between the indications for the first and second PVB was determined. The proportion with recurrent spontaneous periviable birth (SPB) was evaluated using contingency tables and McNemar's test, as appropriate. Proximate causes among those with >2 PVBs were also reviewed. Of 91 included gravidas, 61% were African American, 29% were Caucasian, and 10% were Hispanic. 22% were primigravid and 44% were nulliparous in the 1st pregnancy. Causes of delivery were similar between 1st and 2nd deliveries: Preterm Labor (PTL: 48 & 49%), PROM (29 & 25%), Cervical Insufficiency (CI: 11 & 11%), Antepartum Hemorrhage (4.4 & 7.7%), Fetal Death (4.4 & 3.3%), and Preeclampsia (3.3 & 2.2%), respectively. SPB resulted in 88 & 86% of PVBs in the 1st and 2nd pregnancy, respectively. PTL and PROM recurred in 61% and 35% of cases, while CI recurred in 100% of cases. Overall 50 of 91 (55%) repeat PVBs were for the same indication in both deliveries. SPB (due to PTL, PROM or CI) recurred in 73 0f 80 cases (91%). McNemar's test failed to refute the null hypothesis that the causes of 1st and 2nd PVB were dissimilar (P=.77, Kappa=.42). Seven of 91 women had multiple PVBs (22 in total), all due to SPB, and 4 of these (57%) had repeated PVBs due to CI (12 in total). When periviable birth recurs, the causes of the 1st and 2nd delivery are similar, particularly when the 1st results from SPB. CI is a disproportionately frequent cause of multiple (>2) periviable births.

OBJECTIVE: To assess whether there are evident adverse effects of 17 alpha-hydroxyprogesterone caproate after in utero exposure.METHODS: This study evaluated surviving children of mothers who participated in a multicenter placebocontrolled trial of weekly intramuscular 17 alpha-hydroxyprogesterone caproate, with a 2:1 allocation to 17 a-hydroxyprogesterone caproate and placebo, respectively. The guardian was interviewed about the child's general health. Children underwent a physical examination and developmental screen with the Ages and Stages Questionnaire. Gender-specific roles were assessed with the Preschool Activities Inventory.RESULTS: Of 348 eligible surviving children, 278 (80%) were avalilable for evaluation (194 in the 17 alpha-hydroxyprogestrone caproate group and 84 in the placebo group). The mean age at follow-up was 48 months. No significant differences were seen in health status or physical examination, including genital anomalies, between 17 alpha-hydroxyprogesterone caproate and placebo children. Scores for gender-specific roles (Preschool Activities Inventory) were within the normal range and similar between 17 alpha-hydroxyprogesterone caproate and placebo groups.CONCLUSION: 17 alpha-hydroxyprogesterone caproate seems to be safe for the fetus when administered in the second and third trimesters.

BACKGROUND:The proportion of women who attempt vaginal delivery after prior cesarean delivery has decreased largely because of concern about safety. The absolute and relative risks associated with a trial of labor in women with a history of cesarean delivery, as compared with elective repeated cesarean delivery without labor, are uncertain.METHODS:We conducted a prospective four-year observational study of all women with a singleton gestation and a prior cesarean delivery at 19 academic medical centers. Maternal and perinatal outcomes were compared between women who underwent a trial of labor and women who had an elective repeated cesarean delivery without labor.RESULTS:Vaginal delivery was attempted by 17,898 women, and 15,801 women underwent elective repeated cesarean delivery without labor. Symptomatic uterine rupture occurred in 124 women who underwent a trial of labor (0.7 percent). Hypoxic-ischemic encephalopathy occurred in no infants whose mothers underwent elective repeated cesarean delivery and in 12 infants born at term whose mothers underwent a trial of labor (P<0.001). Seven of these cases of hypoxic-ischemic encephalopathy followed uterine rupture (absolute risk, 0.46 per 1000 women at term undergoing a trial of labor), including two neonatal deaths. The rate of endometritis was higher in women undergoing a trial of labor than in women undergoing repeated elective cesarean delivery (2.9 percent vs. 1.8 percent), as was the rate of blood transfusion (1.7 percent vs. 1.0 percent). The frequency of hysterectomy and of maternal death did not differ significantly between groups (0.2 percent vs. 0.3 percent, and 0.02 percent vs. 0.04 percent, respectively).CONCLUSIONS:A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low. This information is relevant for counseling women about their choices after a cesarean section.

Objective: Early preterm birth at 20 to 26 weeks of gestation (periviable birth) carries extreme risks of infant death and morbidities. Prevention of periviable birth could improve infant outcomes significantly. We sought to characterize the causes of periviable birth and to determine whether periviable birth can be predicted by previous pregnancy outcome.Study design: We evaluated 104,921 pregnancies (1974-2004) and assessed the frequency and causes of periviable birth. Women who were delivered of both their first and second pregnancies at >20 weeks of gestation at our institution were identified. Predictive values of the first pregnancy outcomes for second pregnancy outcomes were determined.Results: Periviable birth complicated 1981 deliveries (1.9%). Seventy-nine percent of the women with periviable births had no history of periviable births; 44% of the women had no previous deliveries, and 35% of the women had previous term deliveries only. Causes of periviable birth were labor (36%), premature rupture of membranes (34%), bleeding (10%), and preeclampsia (4%). Four percent of the gestations were multiple gestations. Among 7970 pregnancies at > 20 weeks of gestation, periviable birth in the first pregnancy was associated with preterm birth and periviable birth in the second pregnancy (35.6%, 6.9%; relative risk, 3.3 and 8.6; P < .0001). Periviable birth and preterm birth in the first pregnancy were insensitive for periviable birth in the second pregnancy (8.8%, 36.8%, respectively).Conclusion: Although periviable birth is associated with subsequent periviable birth and preterm birth, preterm, birth and periviable birth are insensitive markers for recurrences in the next pregnancy. Early pregnancy or preconceptional markers for prediction of periviable birth are needed. (C) 2005 Mosby, Inc. All rights reserved.

It has been reported that low infant birth-weight (bBWT) is more likely if maternal BWT (mBWT) was also low. It is not known if this reflects increased preterm birth (PTB) or low-BWT (LBW) at term in these mothers and babies. We sought to determine if women born preterm are more likely to deliver preterm, or if the tendency to repeat LBW across generations reflects LBW at term. From our electronic perinatal database (1974-2004) we identified women who were born and delivered at our institution. Only those born of and delivering a singleton gestation > = 20 weeks were included. Only the 1st delivery for each was analyzed. Maternal gestational age (mEGA) and mBWT were correlated to their baby´s EGA (bEGA) and bBWT. The likelihood of delivering bPTB (<37 weeks) and bLBW (<2,500 grams) based on a history of mPTB or mLBW were calculated. Sub-analysis regarding LBW was performed for those born and delivering at term only. p<0.05 was considered significant. 3,331 women, born and delivered at our institution, met inclusion criteria. They were 52% Afr. American, 35% Caucasian, 10% Hispanic. Pregnancy complications were; 4.7% preeclampsia, 4.6% preterm labor, and 2.3% PROM. While bEGA increased with increasing mEGA (p = 0.002) the correlation was poor (R2 = 0.003). Those with mPTB did not have more frequent bPTBs (13.7 vs11.1%, p = 0.13) or bPTB<32 weeks (3.8 vs 3.2%, p =0.49) than those born at term. bBWT increased with mBWT (p<0.0001, R2 = 0.04). LBW mothers delivered more LBW babies (19.7 vs 10.6%, p<0.0001) than those born >2500 gms. For those born and delivering at term, LBW mothers also had more LBW babies (8.1 vs 3.9%, p = 0.009). ANOVA revealed bLBW to be associated with bPTB (p<0.0001), and mLBW (p = 0.036), but not mPTB (p = 0.89). bPTB was not associated with mPTB (p = 0.79) after controlling mLBW (p = 0.034). For singleton pregnancies, women born preterm are NOT more likely to deliver preterm. Infant LBW is associated with PTB and maternal LBW, but not with maternal PTB. Maternal LBW at term IS associated with LBW in their term offspring.

Delivery near the limit of viability carries extreme risk of infant death and serious morbidities. Prevention of periviable birth (PVBL) at 20-266 weeks, or even brief delay in delivery, could dramatically improve infant outcomes. Women with a preterm birth (PTB) are at risk for subsequent PTB. Data specific to prediction of PVBL are lacking. We sought to characterize the proximate causes of PVBL and determine if PVBL can be predicted by prior pregnancy history. We evaluated data from a single institution from 1974-2004. Data was collected by chart review at time of discharge, stored in our database. We evaluated clinically relevant data likely to be accurately documented; gestational age (best estimate), birth weight (BWT), admission and delivery indications, and GTPAL. Women with improbable data related to PVBL were excluded. The frequency and causes of PVBL were assessed. To determine PVBL recurrence risk, we evaluated those delivering PVBL in their 1st pregnancy (Preg1) who subsequently delivered their 2nd viable pregnancy (Preg2) at this institution, "P12"s. 1984 of 104,921 included deliveries were PVBLs (1.9%). 81% of PVBLs had no prior suggestive history (46%: no prior deliveries, 35% only prior term deliveries). Proximate causes of PVBL were: labor (37%), PROM (34%), vaginal bleeding (10%) preeclampsia (6%), fetal abnormalities (2.6%). 7.8% of PVBL deliveries were multiple gestations. There were 7,970 "P12"s. After a PVBL in Preg1; Preg2s had more PTBs, and PVBLs (35.6, and 6.9, Relative Risk:3.3 and 8.6). PVBL in Preg1 was insensitive for PVBL in Preg2 (8.8%). PTB in Preg1 was more sensitive but had a low predictive value for PVBL in Preg2 (36.8 and2.5%). Similar findings were found for prediction of BWT <1000 g. The causes of PVBL birth at 20-26 weeks are diverse. Most women with PVBL have no history of prior PTB. A history of PVBL is neither sensitive nor predictive for subsequent PVBL. Alternative early pregnancy markers are needed for PVBL prediction and prevention.

OBJECTIVE: The purpose of this study was to correlate low maternal pregravid weight, delivery weight, and poor gestational weight gain with perinatal outcomes.STUDY DESIGN: Maternal and perinatal data from January 1997 to June 2001 were obtained from a perinatal database at MetroHealth Medical Center. Low maternal weight (LMW) was defined as pregravid or delivery weight <100 pounds or body mass index (BMI) less than or equal to19.8 kg/m(2). Low maternal weight gain was defined as <0.27 kg per week, Perinatal complication rates in these subjects were compared with those with weights of 100 to 200 pounds, normal BMI (>19.8, <26 kg/m(2)), and normal gestational weight gain (0.27-0.52 kg/wk). Chi-square and t tests were used where appropriate. P < .05 was significant.RESULTS: A percentage (2.6%) of 15,196 subjects began pregnancy weighing :100 pounds; 0.15% weighed <100 pounds at delivery and 13.2% had a pregravid BMI less than or equal to19.8 kg/m(2). Pregravid LMW was highly correlated with ethnicity (Asians, 8.6%; Hispanics, 4.3%; Caucasians, 2.5%; African Americans, 1.9%; P < .001). Subjects with pregravid LMW were at increased risk for intrauterine growth restriction (IUGR) (relative risk [RR], 2.3, 95% CI, 1.3-4.05), and perineal tears (3rd-degree lacerations; RR, 1.8, 95% CI, 1.1-2.9), and low birth weight ([LBW] <2500 g; RR, 1.8, 95% CI, 1.1-2.9). They had a lower risk of cesarean section (RR, 0.72, 95% CI, 0.56-0.92) and preterm delivery (PTD) (RR, 1.1, 95% CI, 0.97-1.06). Pregravid BMI <19.8 kg/m2 was associated with preterm labor (PTL) (RR, 1.22, 95% CI, 1.02-1.46), IUGR (RR, 1.67, 95% CI, 1.2-2.39), and LBW (<2500 g; RR, 1.13, 95% CI, 1.0-1.27) and was protective against cesarean delivery (RR, 0.8, 95% CI, 0.71-0.91). Delivery LMW was associated with LBW (<2500 g; RR, 2.81, 95% CI, 1.62-4.84), active-phase arrest (RR, 5.07, 95% CI, 1.85-13.9), PTL and PTD (RR, 2.5, 95% CI, 1.02-6.33, and RR, 2.45, 95% CI, 1.4-.4, respectively), a lower gestational age at delivery (36.8 vs 38.3 wks, P < .05), and mediolateral episiotomy (RR, 9.6, 95% CI, 1.9-48.0). A percentage (0.8%) of subjects had BMI <19.8 kg/m(2) at delivery. Low delivery BMI was associated with birth weight <2500 g (RR, 1.74, 95% CI, 1.3-2.32), PTL (FIR, 2.16, 95% CI, 1.45-3.19), and PTD (RR, 1.57, 95% CI, 1.18-2.11). Failure to thrive in pregnancy (weight gain <0.27 kg/wk) was associated with LBW (<1500 g; RR, 1.23, 95% CI, 1.03-1.45), <2500 g; RR, 1.22, 95% CI, 1.13-1.33), and PTL and PTD (RR, 1.2, 95% CI, 1.05-1.37, and RR, 1.11, 95% CI, 1.02-1.2, respectively).CONCLUSION: Low weight and BMI at conception or delivery, as well as poor weight gain during pregnancy, are associated with LBW, prematurity, and maternal delivery complications.

Suspected macrosomia (SM) is often an indication for labor induction. We sought to determine the impact of suspected macrosomia on labor course and outcome in women induced for this indication. Women with intact membranes and no contractions who were induced between 1/97 and 6/03 were identified from the perinatal database of this urban tertiary care center. Those delivering before 37 weeks, with multifetal gestations, prior cesarean delivery (CD), fetal demise, malpresentation, or a contraindication to labor/vaginal delivery were excluded. Clinical characteristics and delivery outcomes of those with and without SM were compared. We performed similar analyses for those undergoing labor induction for SM only and those with no evident medical indication ("social" induction, N = 313). P < 0.05 was considered significant. 144 SM and 2564 non-SM women met inclusion criteria. SM women were more likely to have gestational diabetes (18% vs 9%) and less likely to have preeclampsia (3% vs 14%) or be induced ≤41 weeks (15% vs 44%), P < 0.02 for each. Cervical dilation, effacement, and station were similar between the two groups (P > 0.30 for each). CD was more common (38% vs 21%), and estimated blood loss, greater with SM (EBL: 504 vs 408 mL), P < 0.0001 for each. For those delivering vaginally, the SM group had longer 2nd stages (57 vs 35 min) and larger infants (3891 vs 3345 g), P ≤ 0.0001 for each, but not more shoulder dystocia (5.5% vs 2.8%, P = 0.18). Compared with "social" induction, SM had larger infants (3955 vs 3310 g), longer admission to delivery time (14.5 vs 12.7 hr) and 2nd stages (49 vs 29 min), and more CDs (34.9% vs 15.8%) and EBL (464 vs 376 mL), P < 0.03 for each. SM is associated with an increased risk of CD, longer second stage of labor, and more blood loss when compared with all other inductions and inductions for no evident medical indication at term.

OBJECTIVE The purpose of this study was to evaluate the changing prevalence of maternal obesity in an urban center. STUDY DESIGN The prevalence of obesity in 31,542 pregnancies from January 1986 to December 1996 (group 1) was compared with the prevalence of obesity in 15,600 pregnancies between January 1997 and June 2001 (group 2). Maternal weight was divided into two groups according to measurements performed at delivery (200 pounds). Women who weighed >or=200 pounds were divided into subgroups for analysis (201-250 pounds, 251-300 pounds, and >300 pounds). The incidence of obesity by weight group was evaluated for a change over time; the impact of race and socioeconomic status was analyzed. A probability value of <.05 was considered significant. RESULTS Maternal obesity was significantly more common in group 2 (>200 pounds: 28% vs 21%; relative risk, 1.3; 95% CI, 1.3-1.4; 201-250 pounds: 20% vs 16%; relative risk, 1.3; 95% CI, 1.2-1.3; 251-300 pounds: 5.5% vs 3.7%; relative risk, 1.5; 95% CI, 1.3-1.6; >300 pounds: 1.6% vs 1.2%; relative risk, 1.4; 95% CI,1.2-1.7; P <.001 for each). Obesity was most common in African American women (>200 pounds, 28.1%; 201-250 pounds, 20.5%; 251-300 pounds, 5.5%; and >300 pounds, 2.1 %). The prevalence of obesity increased most among African American women (>200 pounds: 35 % vs 25%; relative risk, 1.4; 95% CI, 1.4-1.5; 201-250 pounds: 25 % vs 18%; relative risk, 1.4; 95% CI, 1.3-1.5; 251-300 pounds: 7.3 % vs 4.6%; relative risk, 1.6; 95% CI, 1.4-1.6; >300 pounds: 2.7% vs 1.8%; relative risk, 1.5; 95% CI, 1.3-1.9; P <.001 for each), and it decreased in Asian women (>200 pounds: 6.8% vs 11%; relative risk, 0.6; 95% CI, 0.4-0.9; P <.05; 201-250 pounds: 6.3% vs 9.7%; relative risk, 0.6; 95% CI, 0.4 -1.1; P >.05; 251-300 pounds: 0.6% vs 1%; relative risk, 0.6; 95% CI, 0.1- 2.9; P >.05; >300 pounds: 0.0% vs 0.3%). The increase in weight over time remained statistically significant after being controlled in multivariate analysis for socioeconomic status and race. Women with milder obesity (201-250 pounds prepregnancy weight) were at increased risk for preeclampsia, gestational and insulin-dependent diabetes mellitus, advanced gestational age (>or=42 weeks), fetal macrosomia, and cesarean delivery (P <.001 for each), with increasing weight being associated with higher risk. CONCLUSION Obesity that complicates pregnancy has increased significantly over the past 15 years. The risk of perinatal complications increases with increasing maternal pregravid weight; even those women with moderate obesity are at increased risk of adverse outcomes.